Opioid Therapy in the Military: New Treatment Guidance and Clinical Support Tools

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By Laura Faulconer, M.S.W.
July 24, 2017

We’ve all heard about the current opioid epidemic and the increase in the number of deaths due to opioid overdose. Let’s quickly review:

What is the impact of this epidemic on service members? We know prescription opioid medication abuse in service members negatively impacts performance, military readiness and the overall mission. But the data is encouraging.

One study found that chronic pain and prescription opioid use rates in the military were approximately 44 percent higher than in the general population, possibly related to deployment effects such as injuries, combat exposure and mental health conditions. Yet prescription drug abuse in the military is low and on the decline. According to the Military Health System Data Repository, there was a 34 percent decrease in the number of service members receiving a diagnosis of opioid drug dependence or opioid abuse from 2012 to 2016 and opiate positive drug tests among service members declined more than 60 percent between fiscal years 2013 and 2016.

As clinicians we know that continuous education (our own as well as for service members) is important to remind them of the zero tolerance policies for prescription drug abuse, to increase awareness of the health and safety risks of drug misuse and abuse, and to teach how to safely and properly use and dispose of prescription drugs. The VA/DoD Clinical Practice Guideline on Opioid Therapy for Chronic Pain was released February 2017 and new clinical support tools are available to assist you and your patients with easy-to-read, practical information on opioid treatment. Army, Air Force and Navy medical treatment facilities can order hard copies of the tools on the Army Medical Command clinical practice guidelines tool kit shopping cart website and anyone can download the materials via the links below.

  • Therapy Pocket Card* Pocket card with algorithms for assessment, start of trial and discontinuation of opioid therapy as well as  recommended treatment for opioid misuse

    Patient Information Guide: Long-term Opioid Therapy for Chronic Pain Patient booklet that highlights responsible use of opioids, benefits and risks of opioid therapy, and self-management tips

  • Managing Side Effects and Complications of Opioid Therapy for Chronic Pain Fact sheet for primary care providers that explains how to properly manage side effects of opioid therapy.
  • Opioid Therapy for Chronic Pain Pocket Guide (Coming Soon) — Tabbed pocket guide to help providers assess the risks and benefits of initiating or continuing  opioid therapy and recommended strategies for managing tapering, withdrawal and discontinuation
  • Tapering and Discontinuing Opioids (Coming Soon) — Brochure for primary care providers on strategies to safely taper, manage withdraw and discontinue long-term opioid therapy

*Developed by the Department of Veterans Affairs

Ms. Laura Faulconer is a contracted social worker subject matter expert on the evidence-based practice team at the Deployment Health Clinical Center. She has a master of social work and a master of public administration.


The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.


Comments

  • Hi ,
    This is my opinion :
    I've tried every option for pain relief . Shots , rehab , pills , surgery , etc ... I have been going to appointments for 2-3 days a week , sometimes 5 days a week for the last 8 years . At the very minimum, I am admitted to the hospital once every two to three months . I have been admitted a couple of times for 2 weeks or more . I was in so much pain , and all they gave me was ibuprofen and aspirin . For three days , I was in excruciating 😖 pain and constantly asking for pain relief . The only reason I finally fell asleep , was because I snapped and said I didn't want to live if I was going to be in this kind of pain . Is this the way it should be ? The psychiatrists came in and almost immediately , I received pain medication that worked . Yes , an opioid .
    There needs to be some sort of differentiation between abuse and the NEED , not the WANT to have pain relief . The method now in place does nothing to reduce the suicide rate . In fact , it escalates it . People who have been getting pain relief for years due to unfixable problems , suddenly their medicine is stopped . No weening off of the drug . Just stopped refilling the prescriptions. Then , the doctors , who don't want to look bad because they know the person needs this relief but he will get flagged for issuing the pain pills , passes the buck to the pain management clinic who starts treatment all over again . The same stuff they that the patient had already done in the past , knowing it wasn't going to work .
    Just a horrible situation. Since the vet cannot get the pain relief he needs ,
    He goes to the streets to find relief . Then the overdoses happen , whether intentional or not , doesn't matter . The fact is that it could of been prevented at the VA level .
    I live in a place that houses homeless or unstable vets who are going through rehab ..
    The intention of helping these vets is well meant but what do u think happens when they go to this facility that is located in a horrible part of town ? I can walk out the front door and within 5 minutes , someone is trying to sell me crack . Then add in the 1st of the month payday scenario where drug dealers sit in the parking lot honking their horns to alert the vets that the drugstore is open . They come down to purchase and head back to their rooms . Later that night , someone lets in prostitutes that go door to door soliciting vets . Eventually , someone is going to bring this to the attention of the media . I'll have a clear conscious , since I have mentioned these issues in the past . I'm grateful for living hear because otherwise I would be on the street . I myself am strong enough to fight these triggers but many of the vets cannot . They get kicked out and then are back on the street . At least75% of the people living here have a active drug problem .The whole system is set to fail . Instead of punishing the people who need pain relief in opioids form , start helping vets who are sent to places to live while seeking help but are immediately sucked back into the dark shadows of an area where relapse is almost guaranteed.
    Having said this , I love the VA . My issue is that other VA's aren't up to same standard as the VA I go to .
    Sorry I went off topic but it all fits together in the scheme of things .
    Respectfully Submitted ,
    USMC Vet

  • The author does not break down the number of people on legal prescribed opioids who have overdosed or died. This number is so important, that without it, it makes her article very weak. I have seen on two opioids for over 10 years with no negative affects. Without these medications, my quality of health would be about a 2 on a scale of 10. Additionally, the author states that the number of opioids prescribed has decreased dramatically. The reason for this is that the DEA has put the hammer down on any doctor who prescribe opioids. This is not the ethical way to reduce opioids. Quality of life should always be the defining requirement.

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The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.